Use of the ADAPTE method to develop a clinical guideline for the improvement of psychoses and schizophrenia care: Example of involvement and participation of patients and family caregivers.

INTRODUCTION: The aim of this study is to analyse different ways of participation during the development of a clinical guideline to improve the early detection of psychosis and to deploy a comprehensive treatment plan to improve prognosis and social integration. MATERIALS AND METHOD: The clinical guideline was developed using the ADAPTE method with the participation of 40 authors and 80 external reviewers. The process was divided into three major phases: set up, adaptation and finalization. During adaptation and completion, a total of 44 patients and 18 family caregivers were involved. RESULTS AND CONCLUSIONS: The different roles assumed by the patients and their family caregivers were described, depending on the panel in which they participated, with diverse grades of complexity: a user as author, integration of the results of qualitative research with the participation of local users and family caregivers, 13 users as individual external reviewers and the participation of users and caregiver organizations in the external review. In the guideline, contributions from patients during the qualitative research were included in an innovative way, placing them just behind the recommendations. On the other hand, the results of the family caregivers' study were included in a specific area of uncertainty. Further, the expressed point of view was considered as the collective demands of users and family caregivers' organizations in the cost-benefit analysis made by the organizing committee. There were diverse ways to conduct direct patient participation during the guideline development, ensuring that their individual experiences contributed significantly to the final version.

Efficacy of low-intensity psychological intervention applied by ICTs for the treatment of depression in primary care: a controlled trial.

BACKGROUND: Depression is one of the most common disorders in Psychiatric and Primary Care settings and is associated with significant disability and economic costs. Low-intensity psychological interventions applied by Information and Communication Technologies (ICTs) could be an efficacious and cost-effective therapeutic option for the treatment of depression. The aim of this study is to assess 3 low-intensity psychological interventions applied by ICTs (healthy lifestyle, positive affect and mindfulness) in Primary Care; significant efficacy for depression treatment has previously showed in specialized clinical settings by those interventions, but ICTs were not used. METHOD: Multicenter controlled randomized clinical trial in 4 parallel groups. Interventions have been designed and on-line device adaptation has been carried out. Subsequently, the randomized controlled clinical trial will be conducted. A sample of N = 240 mild and moderate depressed patients will be recruited and assessed in Primary Care settings. Patients will be randomly assigned to a) healthy lifestyle psychoeducational program + improved primary care usual treatment (ITAU), b) focused program on positive affect promotion + ITAU c) mindfulness + ITAU or d) ITAU. The intervention format will be one face to face session and four ICTs on-line modules. Patients will be diagnosed with MINI psychiatric interview. Main outcome will be PHQ-9 score. They will be also assessed by SF-12 Health Survey, Client Service Receipt Inventory, EuroQoL-5D questionnaire, Positive and Negative Affect Scale, Five Facet Mindfulness Questionnaire and the Pemberton Happiness Index. Patients will be assessed at baseline, post, 6 and 12 post-treatment months. An intention to treat and per protocol analysis will be performed. DISCUSSION: Low-intensity psychological interventions applied by Information and Communication Technologies have been not used before in Spain and could be an efficacious and cost-effective therapeutic option for depression treatment. The strength of the study is that it is the first multicenter controlled randomized clinical trial of three low intensity and self-guided interventions applied by ICTs (healthy lifestyle psychoeducational program; focused program on positive affect promotion and brief intervention based on mindfulness) in Primary Care settings. TRIAL REGISTRATION: Current Controlled Trials ISRCTN82388279 . Registered 16 April 2014.

Off-axis vortex breakdown in a shallow whirlpool.

The off-axis emergence of vortex breakdown (VB) is revealed. The steady axisymmetric flow in a vertical sealed cylinder, which is partially filled with water and the rest is filled with air, is driven by the rotating bottom disk. The numerical simulations show that VB can emerge away from the rotation axis, interface, and walls. As the rotation intensifies, VB first develops in the water region. If the water height is less (larger) than nearly one half of the cylinder radius, VB emerges off (on) the axis. As the rotation further increases, the off-axis VB ring touches the interface and then a thin countercirculation layer develops in the air flow above the water VB domain. This two-fluid VB ring shrinks (it even disappears in a very shallow whirlpool) as the interface approaches the bottom disk.

The Malaga schizophrenia case-register (RESMA): overview of methodology and patient cohort.

BACKGROUND: Little information has become available after psychiatric reforms regarding outcomes of persons with schizophrenia and related disorders cared for in community-based mental health facilities. AIMS: The aim of this study was to determine the consequences of psychiatric services in the users of mental health services in Malaga. METHOD: We describe the cohort and methods involved in the Schizophrenia Case Register (RESMA) in Malaga, Spain. All cases (n = 1,022) were users of public mental health services provided in the catchment area over one year. The majority were male (65%), single (68%), living with their original family (50%), with primary education (41%) and living on disability benefits (52%). RESULTS: Concerning use of services, the majority had out-patient contacts (89%). RESULT: s show a substantial overlap in the use of different services during the study period. CONCLUSION: The Malaga Schizophrenia Case Register provides sociodemographic, clinical and service use information for a large sample of patients with schizophrenia or related disorders. Results obtained from the cohort studied will be instrumental for the follow-up and evaluation of the mental health care reform.

Complications in medial meniscus suture: a cadaveric study.

The aim of this study was to examine the possibility of complications in medial meniscus repair using an inside-out suturing device. Anatomical cadaveric study. Six fresh frozen cadaveric lower limbs were used. The posterior horn of the medial meniscus was sutured using three vertical stitches. An anatomical dissection was subsequently performed to check for any possible effects upon the structures of the medial aspect of the knee. In addition, an incision was made in a safety zone in order to ascertain whether it was possible to carry out the suture without affecting the aforementioned structures. No vascular or nervous structures were pierced by the needle. On knotting, it was found that a number of different structures had become trapped: the sartorial tendon was affected in each of the specimens used. In four cases, the saphenous vein was trapped by some of the knots. The saphenous nerve was trapped in four instances. Once this had been established, a small accessory incision was made to provide access to a safety zone, where suture can be performed without affecting any neurovascular or tendinous structures. Inside-out suture of the posterior meniscal horn carries a high incidence of entrapment of the neurovascular structures of the medial aspect of the knee. The sartorial tendon is constantly affected. Such complications can easily be avoided by entering the safety zone via a small auxiliary incision. This study provides evidence that complications affecting the peripheral structures of the medial aspect of the knee may arise during inside-out suture of the posterior horn of the medial meniscus and proposes a simple method of averting them.

Utilidad de broncofibroscopia flexible en el diagnóstico de las causas de hemoptisis / Utility of broncofibroscopia flex in the diagnosis of the reasons of hemoptisis

Se realizó estudio descriptivo prospectivo para evaluar la utilidad de la broncofibroscopia flexible en el diagnóstico de las causas de hemoptisis. Se realizaron 60 broncofibroscopias. Las hipótesis planteadas como primera posibilidad fueron de etiología Infecciosa 52 (86.7 por ciento), de etiología neoplßsica 6 (10 por ciento) y de otras causas 2 (3.3 por ciento). Resultados Bacteriológicos: de 48 pacientes con sospecha de tuberculosis 12 (25 por ciento) resultaron con baciloscopias positivas; obteniéndose el mejor rendimiento mediante el aspirado bronquial (100 por ciento). De 17 pacientes con sospecha de otra causa infecciosa 11 (64.7 por ciento) resultarón positivas para gérmenes comunes y hongos y 6 (35.3 por ciento) negativas. De 14 pacientes con estudio citológico de papanicolau (PAP)13 (92.9 por ciento) no presentaron Células Sospechosas de Neoplasias (NCSN) y en 1 (7.1 por ciento) se evidenciaron Células Sospechosas de Neoplasia (CSN). En 41 pacientes con biopsias bronquiales los resultados fueron: bronquitis crónica 25 (61 por ciento), bronquitis crónica y aguda 07 (17.1 por ciento), metaplasia epidermoide 02 (4.9 por ciento), granuloma tuberculoso 02 (4.9 por ciento), y 5 (12 por ciento) fueron informadas como muestra insuficiente. Conclusiones: Se demostró la importancia de la broncofibroscopía flexible en el diagnóstico de las causas de hemoptisis en nuestro medio, siendo el mayor aporte en la detección precoz de enfermedades infecciosas posibilitando su tratamiento oportuno con importantes beneficios epidemiológicos.

A descriptive and prospective study to evaluate utility of fiberoptic bronchoscopy in the diagnosis in hemoptisis was undertaken. Sixty fiberoptic bronchoscopy were done.The raised hypotheses as first possibility were of infectious etiology 52 (86.7 per cent) of neoplasic etiology 6 (10 per cent) and of other causes 2 (3,3 per cent). Bacteriological results: among 48 patients (with suspect tuberculosis), 12 patients (25 per cent) had positive acid fast bacilli smears. Among 17 samples that under went routine bacterial culture testing, 11 samples grew bacteria and fungal culture were positive, in 6(35.3 per cent) were negative. Cytological results: papanicolao smears were done in 14 patients, in 1 patients (7.1 per cent) suspicious neoplastic cells were detected. Histological results: In 41 patients, biopsy specimens were obtained, the following results were seen :: chronic inflammation in 25 (61 per cent), chronic and acute bronchitis in7 (17,1 per cent), epidermoid metaplasia 2 (4,9 per cent ), tuberculous granuloma in 2 (4,9 per cent), and 5 (12 per cent) were informed, as it shows insufficient specimens. Conclusions: The importance of the use of the flexible fiberoptic bronchoscopy was demoustrated in the diagnosis of the causes of hemoptisis, contributing the most to the early diagnosis of infectious diseases which results inopportune treatment and epidemiologic benefit.

Knee locking due to a single gouty tophus.

Knee locking is a highly incapacitating condition attributable to mechanical or functional factors. Pain, mostly of capsuloligamentous or intraosseous origin, is the cause of functional locking. Meniscal injuries are the most frequent arthroscopic finding in the locked knee, due to mechanical factors. We describe a patient experiencing locking during extension whose history and examination suggested a tear of the anterior horn of the lateral meniscus of the right knee; a diagnostic/therapeutic arthroscopy revealed an intraarticular gouty tophus growing from the anterior horn of the lateral meniscus.

Off-pump total arterial revascularization: our experience.

BACKGROUND AND AIM: Off-pump coronary artery bypass grafting with both the internal thoracic arteries, such as the Tector technique, can reduce the morbidity associated with extracorporeal circulation and aortic cross-clamp. The aim of the present study is to describe our experience and the results obtained. METHODS: From April 1998 to December 2003, the off-pump Tector technique was performed on 743 patients, of whom 621 were male (83.5%), with a mean age of 65.3 +/- 9.5 years (23-90). Preoperative risk factors were diabetes mellitus in 29.5% and peripheral vasculopathy in 14.7% of the patients. Angiography showed left main disease in 25.6% and triple-vessel disease in 50.3% of the patients, with a mean ejection fraction of 60%+/- 13% (23-88). Both the internal thoracic arteries were harvested using the skeletonization technique and were anastomosed as "Y" or "T" grafts. Intraoperative graft patency was checked using a Doppler flowmeter. RESULTS: A total of 2028 distal anastomoses were performed, the average being 2.7 (1 to 5) per patient. At least three distal anastomoses were undertaken in 62% of the patients. Postoperative complications included atrial fibrillation in 40 patients (5.4%), myocardial infarction in 24 (3.2%), mediastinitis and reoperation for bleeding in 7 (0.9%) and stroke in 3 (0.4%). Twenty-four patients (3.2%) died in the first month postoperatively. CONCLUSIONS: The off-pump Tector technique appears to be safe, showing a low surgical morbidity.

José María Albareda Herrera, una personalidad académica / José María Albareda Herrera, an academician Celebrity

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